Surgical organizer

Certain surgical methods require that multiple instruments be readily available for the physician. For example, vaginal and other perineal surgery is usually performed with patients in the dorsal lithotomy position. The surgeon is positioned at the perineum between the patient's legs, either seated or standing, and often with one or two assistants. The scrub technician stands behind the surgeon and hands them instruments requested during the surgery. These instruments may be located on a sterile field that is located on a table behind the surgeon, and often between the surgeon and the scrub technician. To reduce the amount of time spent turning around and reaching out for instruments, there are several options that have been employed by surgeons in the past. None of those options are ideal.

One concept is to have the primary surgeon seated with a sterile tray placed on his or her lap, on which may be placed instruments for the procedure. These instruments are not usually kept organized by a busy surgeon, leading to confusion and disorganization, and potentially pose a safety hazard, if needles left on needle drivers are placed down on the tray. In addition, the assistants will be standing beside the primary surgeon, and need to lean over in order to assist effectively.

Alternatively, instruments may be placed on the patient's lower abdomen, which is also covered with a sterile drape. In this technique, there often is a lot of clutter, since the instruments are not organized. In addition, heavier instruments, such as weighted vaginal speculums, may not be suitable for placement on the patient's abdomen. Some surgeons will clip instruments (such as hemostats or other clamps) to the drapes near the perineum, which can be unclamped and used during the surgery. The finger holes can also be used to place other instruments within arm's reach. This technique, while adequate for simple procedures, is limited by which types of instruments can be used and either clipped to the sterile drape or placed into the finger holes. If an “under buttocks’ drape is used, the weight of the instruments can also pull the drape out from under the patient, leading to an unsterile field.

Another tool that is often used for vaginal surgery is a self-retaining retractor that employs an outer ring, on which may be attached elastic stays with hooks or clips that can retract and expose tissue. The LONE STAR® retractor system (Cooper Surgical) is an example of one of these commercially available retractors.

Other instruments used in surgery are “tethered”, meaning they have either a cord or tube attached (e.g., Bovie electrocautery, suction tubing, etc.). These tethered instruments often get tangled and can also drop from the surgical field, which renders them unsterile and therefore cannot be used in the surgery, necessitating opening up new instruments.

In some examples, a method of performing a surgery includes providing a surgical organizer having a body, a plurality of instrument-receiving elements, and two opposing terminal arms, the two opposing arms including mating elements, and coupling the surgical organizer via the mating elements to at least one of a drape and a self-retaining retractor.

In some embodiments, a surgical organizer includes a body having two opposing terminal arms, a plurality of instrument-receiving elements disposed on the body, and a mating element coupled to each of the two opposing arms.

Various embodiments of the present invention will now be described with reference to the appended drawings. It is to be appreciated that these drawings depict only some embodiments of the invention and are therefore not to be considered limiting of its scope.

Despite the various improvements that have been made to surgical methods and organizers, conventional devices suffer from some shortcomings as described above. There therefore is a need for further improvements to the devices, systems, and methods of organizing instrumentation during surgery. Among other advantages, the present disclosure may address one or more of these needs.

As used herein, the term “proximal,” when used in connection with a component of a surgical organizer, refers to the end of the component closest to attachment points (e.g., drapes, self-retraining retractor, etc.), whereas the term “distal,” when used in connection with a component of a surgical organizer, refers to the end of the component farthest from the attachment points.

The present disclosure provides a system for organizing surgical instruments during perineal surgery and for use in conjunction with a self-retaining retractor to expose tissues in and around the perineum during gynecologic, urologic, colorectal and other types of surgery. While gynecologists perform much of the surgery in the perineum, other specialists perform perineal surgery, including urologists, colorectal surgeons, and general surgeons, and a perineal surgical organizer would be potentially useful for any of these surgeons. Furthermore, surgeons who perform other types of surgery (e.g., abdominal, laparoscopic, back, extremity, head and neck) may benefit from drapes that have surgical instrument organizers so that commonly used instruments can be more accessible to the surgeon.

1 FIG. 100 101 101 100 102 103 103 104 104 105 106 107 103 107 102 illustrate a first embodiment of a surgical organizerthat may be used in combination with a self-retaining retractorplaced in the center of the organizer. The self-retaining retractormay be coupleable to surgical organizer or integrated therewith. Surgical organizermay be made of two components, including an upper partconfigured to rest on the lower abdomen of the patient, and a lower partconfigured to hang down from the patient. These two components may be separately formed or unitarily formed. Lower partmay include one or more loopsdisposed on, affixed to, coupled to, or defined by the lower part to hold various surgical instruments, such as scissors or clamps. In addition to loops, one or more holsters may be placed on the sides of the organizer to hold instruments such as a first holsterto retain a first instrument (e.g., a Bovie cautery) and a second holsterto retain a second instrument (e.g., a suction instrument). Optionally, one or more fluid-tight pouchesmay be attached to lower partof the organizer to catch fluid or blood. Pouchmay also be used to hold other instruments, such as retractors and the like. It will be understood that upper partmay likewise have a series of loops, ridges, compartments or pockets to hold various instruments, sponges, or other equipment used in surgery.

100 100 102 103 100 102 103 In this example, the basic configuration of the surgical organizer is that of an apron that is placed after sterile drapes are placed over the patient at the beginning of surgery. Once the patient has been prepped and draped in the lithotomy position, surgical organizeris placed over the perineum so that the organs to be operated on are exposed in the center (e.g., within the self-retaining retractor). Of note, this organizer may also be appropriate (possibly with some modifications) for patients placed in the prone position, for example for colorectal surgery. Surgical organizerincluding upper partand lower partmay be constructed out of one of several different materials, such as paper, fabric, and/or plastic, and the loops may comprise plastics, cloth or other suitable materials to receive various surgical instruments, including scissors, clamps, forceps and retractors. Surgical organizermay also be made of a composite of several different materials. For example, the upper and lower parts,may be formed of paper, while the loops and holsters (for suction and electrocautery instrument) may be molded plastic, and the pouch for drainage of fluids and blood may be transparent flexible plastic, with a malleable plastic rim, which would enable the surgeon to pull the pouch out of variable distances.

2 FIG. 200 100 200 208 208 In a second embodiment, shown in, a surgical organizeris substantially similar to surgical organizerbut can be used without a self-retaining retractor placed in the center of the organizer. In this example, surgical organizermay have a window, such as a vaginal fenestration with adhesive tape on the inner aspect, in order to adhere to the patient's perineum or to drapes that have previously been placed. Windowmay be circular, square, rectangular, triangular, oval or other suitable shape.

3 FIG. 1 FIG. 300 300 309 illustrates another embodiment of a surgical organizerthat is similar to that described in, except that surgical organizerincludes one or more magnetic stripsplaced on the front to hold the metal instruments (e.g., on the upper and/or lower parts of the apron). There may be one or more rows of such magnetic strips, on which instruments or surgical needles are placed and removed.

400 410 400 410 411 412 412 404 4 FIG. In one variation, a surgical organizermay include saddle bags that are placed on the patient's thighs and hang over each side to balance one another as shown in. In this example, the inner sideof the surgical organizermay face the surgeon, and the weight of the inner sidemay be counter balanced by the outer sidehaving pockets. Instruments or other appropriate weight may be placed within pocketsas desired. Optionally, loops, magnetic strips, or other coupling means may be placed in one or more rows on each side, in order to hold instruments.

5 FIG. 500 513 513 513 500 514 500 Turning to, a surgical organizeris shown that may be coupleable to a self-retaining retractor “R”. Instead of being integrated or unitarily formed with the self-retaining retractor, surgical organizer may include terminal armsthat may be clipped or otherwise attached to the self-retaining retractor and hangs off the retractor, in which instruments are stored. In this example, the terminal armsoppose one another and are angled toward one another. In some examples, the terminal armsform an angle α of between 20 degrees and 80 degrees with the lateral axis (e.g., 30, 35 or 40 degrees as shown). In this example, surgical organizermay include one or more instrument loopsmolded as part of the structure. Notably, surgical organizermay hang from the bottom of self-retaining retractor “R” as shown, and is not disposed completely around the circumference of self-retaining retractor “R” as previously described. Additionally, instead of an apron-like configuration, the surgical organizer may include rectangular strips of plastic that are connected together or integrally formed in the shape shown.

6 FIG. 600 600 613 613 623 600 614 605 606 600 In one variation, shown in, a surgical organizermay be coupleable to a self-retaining retractor “R” or drapes. In this example, surgical organizermay include parallel terminal armsthat may be clipped or otherwise attached to another element. In this example, the terminal armsare substantially linear and connected at their base via a bridging member. In this example, surgical organizermay include one or more instrument loopsmolded as part of the structure as well as holsters,. Surgical organizermay be affixed into place via the terminal arms with one of a number of methods, such as an adhesive, VELCRO®, clips and/or counter weights.

7 FIG. 8 FIG. 700 710 730 700 713 713 723 700 714 705 706 700 730 731 731 731 731 705 706 a b Another variation, shown in, includes a surgical organizerhaving a substantially square-shaped bodythat is coupleable to drapes “D” via clips(e.g., badge clips, gator clips, etc.). In this example, surgical organizermay include terminal armsthat may be clipped or otherwise attached to other elements. In this example, the terminal armsare angled toward one another and connected via a bridging member. In this example, surgical organizermay include one or more instrument loopsmolded as part of the structure as well as holsters,.shows a similar surgical organizerbut instead of clips, mating elementsincluding VELCRO hooksand loops(or vice versa) used to couple the surgical organizer to retractor “R”. Instead of hook-and-loop elements, the mating elementsmay instead include hooks, adhesive, magnets, buttons or other coupling means. Thus, a surgical organizer may include interchangeable coupling elements (e.g., clips and loops) that can be chosen based on the surgeon's need. In this example, a first holsteris disposed on one side and a secondary interreference clipis shown that may be used to retain a suction device.

Thus, the present disclosure describes a novel perineal surgical organizer that may incorporate or be attached to a self-retaining retractor to assist with perineal surgery. The organizer may be attached to the standard drapes used for surgery or may use straps that attach the device to the patient. Alternatively, the surgical organizer may be integrated into the drape itself as one unit. In one embodiment, the straps may be placed around the patient's upper thighs to hold the organizer in place. The organizer may have one or more components. In one embodiment, the organizer has two separate components; one that is placed on or below the perineum and is placed in a vertical plane, and the other component on a horizontal plane and is placed on the lower abdomen. Having this other horizontal component would also assist in keeping the organizer in place without slipping. Even with two components, straps may be used to keep the organizer in position. Some drapes do not permit straps to completely encircle the patient's legs. For this situation, the straps may come off the upper aspect of the organizer and be attached to the surgical table or have a weight that hangs down to counter-balance the weight of the instruments placed in the organizer. The organizer may also have clips that attach on to the existing drapes to hold it in position. The organizer itself may be constructed of some light-weight material such as synthetic non-woven fabric (similar to the type of disposable fabric commonly used to construct drapes), cloth, or plastic, either flexible or rigid.

The organizer may have a “cut out” or window for any retractors that may be placed in the vagina or rectum. This cut out may be square, rectangular, or may be of other shapes to accommodate different types of surgery. For example, for perineal surgery requiring access to the inner thigh (such as transobturator slings), the cut out may include “wings”, whereby the skin on the inner thigh is exposed to accommodate surgical access to the obturator foramen. Lateral and inferior to this area, there may be a series of loops, within which are placed various instruments. Instruments to be placed in the loops may include, but are not limited to, scissors, clamps, graspers, and forceps. There may also be holsters located on the front or side of the organizer for tethered tools, such as the Bovie coagulation instrument and suction instruments. The holsters may be of different depths to accommodate the Bovie instrument or suction tip. Suction tips used in surgery come in a variety of different lengths, such as Yankour or Frazier tips. A device in which the suction instruments clips into may be used to hold the suction instrument. Velcro or adhesive straps may also be used to organize the cords or tubing used for these instruments.

There may be one or several rows of loops for placement of instruments. The vertical distance between rows may be organized by the length of the instruments. In cases of scissors, graspers and other clamps that have finger holes, the instruments may be placed in the loops upside-down, since the shaft of the instrument will fit through the loop, but the finger holes will not, thus keeping them organized and in reach of the surgeon. Forceps would be placed “right-side-up” in the loops. Alternatively, one or more magnetic strips may be affixed to the organizer, so that the instruments can be placed against the strips, which will hold them until the surgeon needs to use them.

As discussed, at the bottom of the organizer, there may be a pouch. This pouch may serve several purposes. First, any instruments that are inadvertently dropped may fall into the sterile pouch, so that they may be easily retrieved and reused. In addition, the pouch may catch blood or other fluids, such as irrigation fluid used during surgery such as water or normal saline to flush out wounds or to distend cavities, such as during cystoscopy. Suction tubing may be connected to the bottom of the pouch so that fluids can be drawn away from the pouch. This constant evacuation of accumulated fluids ensures that no significant weight, and therefore downward traction, is experienced from the fluid in the pouch. The pouch can also be used to store larger instruments, such as malleable retractors, Sims retractors, and/or Breisky-Navratil retractors.

Self-retaining retractors may be used along with the surgical organizer, or may be incorporated in the organizer as a single unit. Alternatively, the self-retaining retractor could clip onto the organizer, or have VELCRO or other adhesive-type straps that attach to the self-retaining retractor. If using a double-ring retractor (e.g., Lone Star model #3301G, 3302G, 3304G), a two-component organizer may be preferred—the lower abdominal component may be attached to the upper ring and the lower perineal component may be attached to the lower ring.

Alternatively, the organizer can consist of one or more “saddle-bags” that are placed on the patient's upper or lower legs. There may be an adhesive that keeps the organizer in place. The organizer may have loops for instruments on the inner portion of the leg. The organizer may have an extension on the outside of the leg and may have some counterweight so that it will not be dragged down by heavy instruments placed in loops on the inner leg side

The system may include parts that may be connected together, or may come as a complete surgical kit. It may be preferable to have different available options, since some surgeons may use and others may not use self-retaining retractors.

Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.

It will be appreciated that the various dependent claims and the features set forth therein can be combined in different ways than presented in the initial claims. It will also be appreciated that the features described in connection with individual embodiments may be shared with others of the described embodiments.